Two patients with chronic schizophrenia were admitted with acute pancreatitis. Olanzapine was used by both patients and may represent a further example of drug-induced pancreatitis. Olanzapine is a thienobenzodiazepine similar in structure to clozapine; clozapine has been associated with the induction of acute pancreatitis (Frankenburg & Kando, 1992; Gatto et al, 1998).
A 34-year-old man with chronic schizophrenia was admitted with abdominal pain. Two years previously he had had acute pancreatitis, but continued to drink alcohol (8 units/day). The patient was taking 20 mg olanzapine daily. Glasgow criteria and computed tomography classified the episode as severe pancreatitis. The patient developed respiratory failure and required artificial ventilation for 11 days. A full recovery was made.
A 29-year-old man with chronic schizophrenia was admitted with abdominal pain. He had a past history of acute pancreatitis, having had an attack 8 years previously. The patient drank at least 15 units of alcohol per week. Regular medication was sulpiride and olanzapine 20 mg daily. Diagnosis was made by computed tomography. The patient made an uncomplicated recovery. The same patient was readmitted 4 months later with another attack of acute pancreatitis — he had continued to take olanzapine and to drink alcohol.
Although both patients were regular consumers of alcohol, a known risk factor for the development of acute pancreatitis, we felt it unusual that two patients on olanzapine should present within such a short period of time. Clozapine has been associated with pancreatitis and has a similar structure to olanzapine; one might therefore suspect that olanzapine might cause pancreatitis. The evidence for olanzapine inducing pancreatitis is strengthened by the fact that in one of the patients a further episode occurred after rechallenge with the drug. It is possible that olanzapine acts in a synergistic fashion with alcohol in the pathogenesis of the disease. We propose that olanzapine should be used with caution with patients who drink alcohol on a regular basis or who have a previous history of pancreatitis.
- © 2000 Royal College of Psychiatrists